Bipolar disorder

Bipolar disorder is characterized by mood swings. The episodes of mania and depression can last from a few to several days. The intensity of symptoms can range from extreme highs (mania) to extreme lows (depression). They include:

1. Extreme Low (Depression)

While dealing with a period of depression, the symptoms include:

• Feelings of guilt and despair
• Lack of energy
• Difficulty in concentrating and remembering things
• Feeling hopeless, sad, or irritable most of the time
• Loss of interest in everyday activities
• Difficulty in sleeping
• Lack of appetite
• Suicidal or self-harming thoughts
• Waking up early

Depression is a mood disorder that causes a feeling of extreme sadness, which differentiates it from bipolar disorder, which has its highs and lows. Learn How To Cope With Depression. Tap Here

2. Extreme High (Mania)

The mania phase of bipolar disorder may include:

• Feeling very happy or overjoyed
• Being more active than usual
• Excessive appetite for food and drinks
• Talking very quickly
• Easily irritated or agitated
• Disturbed or illogical thinking
• Insomnia (difficulty falling asleep)
• Easily distracted

Note: A person may experience episodes of depression more regularly than mania in bipolar disorder. Individuals may sometimes experience a normal mood in between these episodes.

The exact cause of bipolar disorder is unknown. However, experts believe that several factors contribute to an individual's likelihood of developing the condition. These factors include:

• Physical factors
• Environmental factors
• Social factors

These elements interact in a complex manner, influencing the risk of developing bipolar disorder.

Researchers are trying to find the possible risk factors of bipolar disorder. Most of them agree that there is no single cause, and it is likely that many factors contribute to a person’s chance of having the illness. Some of the major risk factors include:

• Genetics: Research suggests that bipolar disorder is linked to genetics, as it runs in families. Family members of a person with the disorder have an increased risk of developing it too. A single gene is not responsible for bipolar disorder; instead, a number of genetic and environmental factors act as triggers.
• Chemical imbalance in the brain: The chemical hormones responsible for controlling the functioning of the brain are called neurotransmitters, and bipolar disorder may be associated with chemical imbalances in the brain. An episode of mania may occur when levels of noradrenaline (a neurotransmitter) are too high, while episodes of depression may occur when the level of noradrenaline becomes too low.
• Triggering agents: A stressful condition or situation can trigger the symptoms of bipolar disorder. Examples of stressful triggers include the death of a close family member, the breakdown of a relationship, and physical and emotional abuse.
• Childhood trauma: Studies demonstrate that childhood traumatic events are risk factors for developing bipolar disorders. There is a relationship between the development of bipolar disorder and prior physical, sexual, and emotional abuse.
• Brain structure: Some studies indicate that the brains of people with bipolar disorder may differ from those of individuals who do not have bipolar disorder or any other mental disorder.
• Substance misuse: Bipolar disorder frequently coexists with substance misuse, including cannabis, opioids, cocaine, sedatives, and alcohol.
• Hormonal imbalance: Hormones may play a role in the development and severity of bipolar disorder. Studies suggest that late-onset bipolar disorder may be linked with menopause.
• Medical illness: Bipolar disorder is known to coexist with several medical and psychiatric conditions. Conditions such as asthma, obesity, anxiety disorder, migraine, and head injury are associated with bipolar disorder.

Anxiety can lead to feelings of hopelessness, fear, and several other emotions, while bipolar disorder can involve feelings of both hopelessness and encouragement. Learn more about relaxation techniques to manage stress and anxiety.

To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview, and order lab tests. The diagnosis is based on the following aspects:

1. History and Physical Examination

A general practitioner will assess the individual during the appointment with the following considerations:

• General Appearance: A patient with mania often appears unpredictable and erratic. Unnatural happiness may be observed, although irritability is also common.
• Mood: The mood is typically elevated or euphoric during mania, while in a depressive state, the patient may appear sad or in an elegiac mood.
• Thought Process: Patients with mania exhibit easy distractibility, lack of concentration, and absurd behavior. In contrast, a depressed patient usually has negative thoughts.
• Speech: A depressive patient tends to speak slowly and softly, whereas a manic patient demonstrates pressured speech that is difficult to interrupt.

2. Lab Tests

Bipolar disorder cannot be detected through a blood test or body scan; however, these tests can help rule out other illnesses that may resemble the disorder. Certain blood tests may be necessary to rule out drug toxicity and other medical conditions, including:

• Serum alcohol levels
• Urinalysis
• Thyroid panel

Note: The diagnosis of children and teenagers with bipolar disorder follows the same criteria used for adults. However, children with bipolar disorder are often also diagnosed with other mental health conditions, such as attention-deficit/hyperactivity disorder (ADHD) or behavioral problems.

There is no way to prevent bipolar disorder. However, getting early treatment is the first step in preventing bipolar disorder or other mental health conditions from worsening. Some important considerations include:

• Be vigilant about the warning signs: Handling symptoms early can prevent episodes from worsening. Involve a doctor if any significant changes are noted in a person's behavior and seek early intervention.
• Practice recreational activities: Engaging in sports and physical activities can help improve and manage the symptoms of bipolar disorder. Outdoor activities like hiking, camping, gardening, meditation, and yoga can effectively control mood swings and reduce stress.
• Avoid alcohol, drugs, and smoking: Drug abuse and addiction can cause changes in the brain that lead to bipolar disorder. Alcohol has been known to intensify bipolar disorder due to its sedating effects. Moreover, these substances increase the risk of mood swings, depression, violence, and suicide.

The primary step in the treatment of bipolar disorder is to confirm the diagnosis of mania or hypomania. Most people with bipolar disorder can be treated using a combination of different treatments involving:

I. Medication

• Lithium: This drug is the gold standard for the treatment of bipolar disorder, as long-term use has demonstrated a reduction in suicide risk. Note: Regular blood tests at least every 3 months while taking lithium are mandatory to ensure the lithium levels are not too high or too low.
• Anticonvulsant medicines: Some anticonvulsant medicines include:
  • Valproate
  • Lamotrigine
  • Carbamazepine
• Antipsychotic medicines: These classes of drugs are sometimes prescribed to treat episodes of mania. These include:
  • Haloperidol
  • Olanzapine
  • Quetiapine
  • Risperidone
• Antidepressants: Traditional antidepressants are considered experimental for treating bipolar depression. The class of antidepressants includes:
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine

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II. Cognitive treatment

Cognitive treatment can be helpful when used alongside medications to treat bipolar disorder. This may include:

• Psychoeducation: This combines health psychology with behavioral counseling and psychotherapy. It is important for teaching patients stress management techniques to cope with stressful situations more effectively.
• Cognitive behavioral therapy (CBT): This is a talking therapy that helps manage problems by changing the way one thinks and behaves. It is based on the concept that a person's thoughts, feelings, physical sensations, and actions are interconnected.
• Family Focused therapy (FFT): FFT therapists work to identify difficulties and conflicts within the family that may contribute to patient and family stress. It also educates all family members about the nature of bipolar disorder, its treatment, and ways that family members can best support their affected members.

III. Electroconvulsive Therapy (ECT)

Electroconvulsive therapy, also known as ECT or electroshock therapy, is a short-term treatment for severe manic or depressive episodes, particularly in the case of severe psychotic symptoms or when medications seem to be ineffective.

If bipolar disorder is left untreated, it can lead to longer and more severe mood changes. Someone living with bipolar disorder can also have a higher risk of the following complications:

• Anxiety: A person with bipolar disorder will experience symptoms of anxiety at some point.
• Heart disease: This is a leading cause of death among individuals with severe mental health disorders, including bipolar disorder.
• Suicidal thoughts: Bipolar disorder has the highest rate of suicide among psychiatric conditions.
• Obesity: It is common among individuals with bipolar disorder, who are more frequently overweight or obese.
• Migraine: This is a common complication of bipolar disorder, with nearly one-third of individuals experiencing migraine headaches.

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Every mental health disorder needs comprehensive care. Several alternative treatments aim to reduce anxiety and stress. They include:

• Meditation: It helps in alleviating depressed mood and feelings of helplessness. For people with bipolar disorder, meditation and mindfulness may assist in improving mood, emotional regulation, and stress management over time. Meditation is beneficial for both the soul and body.
• Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT is a common adjunctive therapy for individuals with mood disorders. Its primary focus is on stabilizing the circadian rhythm, a natural internal process that regulates the sleep-wake cycle.
• Acupuncture: This therapy is believed to stimulate the central nervous system. It involves inserting very thin needles into various locations and depths of the body, leading to the release of chemicals into the muscles, spinal cord, and brain, promoting physical and emotional well-being.
• Light Therapy: Also known as phototherapy, this method uses light to treat disorders. It has been used to address seasonal depression and may also be effective for individuals with bipolar disorder. Light therapy amplifies circadian rhythms, reversing symptoms of depression and anxiety.
• Relaxation Techniques: These techniques can refresh both your soul and mind.

There is always a taboo and stigma around mental health, and communicating your thoughts to your loved ones can be a great relief. Some tips that can help caregivers and individuals suffering from bipolar disorder include:

Tips to Help Yourself

Bipolar disorder can exert control over your thoughts and interfere with relationships if not treated. Here are a few ways that can help in managing your illness:

• Establish a routine: Committing to a routine can help in controlling depression and mania.
• Monitor energy changes: Always keep the energy changes caused by depression and mania under check.
• Prioritize sleep: Aim for a sound sleep of eight hours every day.
• Exercise regularly: Indulge in aerobic exercise and walking to keep stress levels under control.
• Learn about sleep aids: Explore six foods that can help you fall asleep.

• Pinpoint your stressors: Identify the times or events that cause stress or triggers. Addressing the symptoms of mania and depression early can help prevent a serious episode.
• Learn from previous episodes: Pattern recognition is essential to spot the early symptoms of an impending manic episode. Taking advice from family members who can recognize these early symptoms is very important.
• Avoid drugs and alcohol: Both substances can cause addiction, emotional imbalance, and interact with medications.

Helping Your Loved Ones

• Recognize the early symptoms: Family members should recognize early signals such as lack of sleep and babbling that can indicate mania. This helps in preventing a serious episode before it occurs.
• React calmly: Even when the person experiencing an episode may go off or rant, it’s important to remain calm. Try to soothe them by listening and making them feel understood.
• Communicate effectively: Make time to discuss the problems the person is facing. Be considerate and listen to their feelings and challenges with empathy.

Remember, you are not alone! Understand ways to manage the stress and anxiety that come along with bipolar disorder.

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